Atherothrombosis and Coronary Artery Disease
http://www.100md.com
《新英格兰医药杂志》
Most of us walk around oblivious to the time bombs that line our arteries. Indeed, atherosclerosis is, for the most part, a rather benign condition that affects, to some degree, virtually all the adult population both in developed countries and in many developing countries. Many adults will die from other causes before atherosclerosis causes overt problems. If the plaque is big enough and sitting in a coronary artery, it may impede blood flow and cause symptoms of angina. But if it is small, the plaque will usually be asymptomatic until the moment it supports thrombosis. The central role of thrombosis in the evolution of atherosclerotic plaque and the denouement in an acute cardiovascular event are well reflected in the title of this impressive book, and the interplay between plaque and thrombus is one of its central themes.
Medical interest in atherosclerosis stretches back at least four centuries, and the book starts with a fascinating history of the disease that should be of interest to many. The mention of Heberden's classic description of angina pectoris reminds us that angina was a common condition in 18th-century London, and W. Bruce Fye's exhortation to reflect on the question, "Where does the review of the literature end and history begin?" — which Fye poses in the first chapter — provides the perfect start to a book that is intended to present the latest views in an area of fast-moving research. The following chapters cover the science of the disease and clinical practice, and the reader can find illustrations ranging from meta-analyses and Kaplan–Meier survival curves to schematic representations of a model of ATP-binding cassette transporters.
Indeed, one of the greatest strengths of this book is the breadth of what is covered, and by selecting some of the leaders in the field as authors, the editors have provided the necessary authority to the writing, even if styles change from section to section. Breadth is important in an era in which doctoral students frequently find themselves working on highly focused projects dissecting a small piece of the puzzle. Even within a small area, subspecialization is becoming increasingly common. I shudder to recall the graduate student who, when asked in an examination how a blood vessel in a particular experiment was contracted before vasorelaxant agents were available, responded, "But my thesis is about dilatation, not contraction." Reestablishing an integrated approach to understanding atherosclerosis and coronary artery disease is clearly important, and this book should be available in any laboratory working in the field. The chapter on mouse models of atherosclerosis will be of value to many.
There is also a lot here for clinicians: clear and helpful explanations of pathophysiology, a dip into more controversial areas such as the effects of viruses on atherothrombosis, and informative sections on current therapeutic approaches. Flipping back and forth between the section on therapeutics and the historical perspective should help to keep the reader from becoming too convinced that we know exactly how to manage our patients' conditions, even in 2005.
So, are there any problems? Of course, there are some inconsistencies and some omissions: Why, for example, is the important side effect of nocturia caused by calcium-channel blockers never mentioned? These minor flaws are not enough to detract from the quality and importance of the book, but I do have a gripe about the quality of the figures. We increasingly depend on visual images in order to learn, and yet the book is packed with rather dull black-and-white images. Some of those in chapter 19 even look as though they were poorly scanned or downloaded. The wonderful color plates in the middle of the book show what can be used, and it would have been nice to have figures of this quality throughout the book. The most important question, however, is whether I would buy this book. The answer is yes.
Patrick Vallance, M.D.
University College London
London WC1E 6JJ, United Kingdom
patrick.vallance@ucl.ac.uk
Medical interest in atherosclerosis stretches back at least four centuries, and the book starts with a fascinating history of the disease that should be of interest to many. The mention of Heberden's classic description of angina pectoris reminds us that angina was a common condition in 18th-century London, and W. Bruce Fye's exhortation to reflect on the question, "Where does the review of the literature end and history begin?" — which Fye poses in the first chapter — provides the perfect start to a book that is intended to present the latest views in an area of fast-moving research. The following chapters cover the science of the disease and clinical practice, and the reader can find illustrations ranging from meta-analyses and Kaplan–Meier survival curves to schematic representations of a model of ATP-binding cassette transporters.
Indeed, one of the greatest strengths of this book is the breadth of what is covered, and by selecting some of the leaders in the field as authors, the editors have provided the necessary authority to the writing, even if styles change from section to section. Breadth is important in an era in which doctoral students frequently find themselves working on highly focused projects dissecting a small piece of the puzzle. Even within a small area, subspecialization is becoming increasingly common. I shudder to recall the graduate student who, when asked in an examination how a blood vessel in a particular experiment was contracted before vasorelaxant agents were available, responded, "But my thesis is about dilatation, not contraction." Reestablishing an integrated approach to understanding atherosclerosis and coronary artery disease is clearly important, and this book should be available in any laboratory working in the field. The chapter on mouse models of atherosclerosis will be of value to many.
There is also a lot here for clinicians: clear and helpful explanations of pathophysiology, a dip into more controversial areas such as the effects of viruses on atherothrombosis, and informative sections on current therapeutic approaches. Flipping back and forth between the section on therapeutics and the historical perspective should help to keep the reader from becoming too convinced that we know exactly how to manage our patients' conditions, even in 2005.
So, are there any problems? Of course, there are some inconsistencies and some omissions: Why, for example, is the important side effect of nocturia caused by calcium-channel blockers never mentioned? These minor flaws are not enough to detract from the quality and importance of the book, but I do have a gripe about the quality of the figures. We increasingly depend on visual images in order to learn, and yet the book is packed with rather dull black-and-white images. Some of those in chapter 19 even look as though they were poorly scanned or downloaded. The wonderful color plates in the middle of the book show what can be used, and it would have been nice to have figures of this quality throughout the book. The most important question, however, is whether I would buy this book. The answer is yes.
Patrick Vallance, M.D.
University College London
London WC1E 6JJ, United Kingdom
patrick.vallance@ucl.ac.uk